An Uncommon Case of Recurrent Spontaneous Coronary Artery Dissection Involving Multiple Coronary Arteries

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of cardiac ischemia that especially affects young women. Its true prevalence is not well established due to limitations in diagnosis. Although the symptoms of SCAD largely mimic those of acute coronary syndrome (ACS), the management is remarkably different. The etiology of SCAD is considered to be multifactorial, and underlying arteriopathic disease, such as fibromuscular dysplasia, is a well-known risk factor. We treated a case of a young woman who had recurrent SCAD involving three different coronary arteries, including the left anterior descending, right coronary artery, and obtuse marginal branch, on two different occasions without any identifiable underlying vascular disease or acute precipitant. She had STEMI (ST-segment elevation myocardial infarction) on her first presentation and NSTEMI (non-ST segment elevation myocardial infarction) on her second presentation nearly two years later. She underwent angiography on both occasions; however, she was treated medically without percutaneous coronary intervention (PCI) and had good outcomes with the resolution of symptoms.